Pub Date : 2019-10-18Print Date: 2020-01-01DOI: 10.3171/2019.8.PEDS19282
Benjamin Davidson, Nathan Schoen, Shaina Sedighim, Renée Haldenby, Blythe Dalziel, Sara Breitbart, Darcy Fehlings, Golda Milo-Manson, Unni G Narayanan, James M Drake, George M Ibrahim
Objective: Cerebral palsy (CP) is the most common childhood physical disability. Historically, children with hypertonia who are nonambulatory (Gross Motor Function Classification System [GMFCS] level IV or V) were considered candidates for intrathecal baclofen (ITB) therapy to facilitate care and mitigate discomfort. Selective dorsal rhizotomy (SDR) was often reserved for ambulant children to improve gait. Recently, case series have suggested SDR as an alternative to ITB in selected children functioning at GMFCS level IV/V. The objective for this study was to systematically review the evidence for ITB and SDR in GMFCS level IV or V children.
Methods: Medline, Embase, Web of Science, and Cochrane databases were systematically searched. Articles were screened using the following inclusion criteria: 1) peer-reviewed articles reporting outcomes after SDR or ITB; 2) outcomes reported using a quantifiable scale or standardized outcome measure; 3) patients were < 19 years old at the time of operation; 4) patients had a diagnosis of CP; 5) patients were GMFCS level IV/V or results were reported based on GMFCS status and included some GMFCS level IV/V patients; 6) article and/or abstract in English; and 7) primary indication for surgery was hypertonia. Included studies were assessed with the Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) tool.
Results: Twenty-seven studies met inclusion criteria. The most commonly reported outcomes were spasticity (on the Mean Ashworth Scale) and gross motor function (using the Gross Motor Function Measure), although other outcomes including frequency of orthopedic procedures and complications were also reported. There is evidence from case series that suggests that both ITB and SDR can lower spasticity and improve gross motor function in this nonambulatory population. Complication rates are decidedly higher after ITB due in part to the ongoing risk of device-related complications. The heterogeneity among study design, patient selection, outcome selection, and follow-up periods was extremely high, preventing meta-analysis. There are no comparative studies, and meaningful health-related quality of life outcomes such as care and comfort are lacking. This review is limited by the high risk of bias among included studies. Studies of SDR or ITB that did not clearly describe patients as being GMFCS level IV/V or nonambulatory were excluded.
Conclusions: There is a lack of evidence comparing the outcomes of ITB and SDR in the nonambulatory CP population. This could be overcome with standardized prospective studies using more robust methodology and relevant outcome measures.
{"title":"Intrathecal baclofen versus selective dorsal rhizotomy for children with cerebral palsy who are nonambulant: a systematic review.","authors":"Benjamin Davidson, Nathan Schoen, Shaina Sedighim, Renée Haldenby, Blythe Dalziel, Sara Breitbart, Darcy Fehlings, Golda Milo-Manson, Unni G Narayanan, James M Drake, George M Ibrahim","doi":"10.3171/2019.8.PEDS19282","DOIUrl":"10.3171/2019.8.PEDS19282","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral palsy (CP) is the most common childhood physical disability. Historically, children with hypertonia who are nonambulatory (Gross Motor Function Classification System [GMFCS] level IV or V) were considered candidates for intrathecal baclofen (ITB) therapy to facilitate care and mitigate discomfort. Selective dorsal rhizotomy (SDR) was often reserved for ambulant children to improve gait. Recently, case series have suggested SDR as an alternative to ITB in selected children functioning at GMFCS level IV/V. The objective for this study was to systematically review the evidence for ITB and SDR in GMFCS level IV or V children.</p><p><strong>Methods: </strong>Medline, Embase, Web of Science, and Cochrane databases were systematically searched. Articles were screened using the following inclusion criteria: 1) peer-reviewed articles reporting outcomes after SDR or ITB; 2) outcomes reported using a quantifiable scale or standardized outcome measure; 3) patients were < 19 years old at the time of operation; 4) patients had a diagnosis of CP; 5) patients were GMFCS level IV/V or results were reported based on GMFCS status and included some GMFCS level IV/V patients; 6) article and/or abstract in English; and 7) primary indication for surgery was hypertonia. Included studies were assessed with the Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) tool.</p><p><strong>Results: </strong>Twenty-seven studies met inclusion criteria. The most commonly reported outcomes were spasticity (on the Mean Ashworth Scale) and gross motor function (using the Gross Motor Function Measure), although other outcomes including frequency of orthopedic procedures and complications were also reported. There is evidence from case series that suggests that both ITB and SDR can lower spasticity and improve gross motor function in this nonambulatory population. Complication rates are decidedly higher after ITB due in part to the ongoing risk of device-related complications. The heterogeneity among study design, patient selection, outcome selection, and follow-up periods was extremely high, preventing meta-analysis. There are no comparative studies, and meaningful health-related quality of life outcomes such as care and comfort are lacking. This review is limited by the high risk of bias among included studies. Studies of SDR or ITB that did not clearly describe patients as being GMFCS level IV/V or nonambulatory were excluded.</p><p><strong>Conclusions: </strong>There is a lack of evidence comparing the outcomes of ITB and SDR in the nonambulatory CP population. This could be overcome with standardized prospective studies using more robust methodology and relevant outcome measures.</p>","PeriodicalId":84131,"journal":{"name":"Allgemeines statistisches Archiv","volume":"90 1","pages":"69-77"},"PeriodicalIF":2.1,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73177777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-11-30DOI: 10.1007/s10182-006-0013-y
M. Fischer
{"title":"\u0000 Zivot Eric and Jiahui Wang, Modeling Financial Time Series with S-PLUS\u0000","authors":"M. Fischer","doi":"10.1007/s10182-006-0013-y","DOIUrl":"https://doi.org/10.1007/s10182-006-0013-y","url":null,"abstract":"","PeriodicalId":84131,"journal":{"name":"Allgemeines statistisches Archiv","volume":"90 1","pages":"631-632"},"PeriodicalIF":0.0,"publicationDate":"2006-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10182-006-0013-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51986396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-11-29DOI: 10.1007/S10182-006-0010-1
Susanne Rässler
{"title":"\u0000 Der Einsatz von Missing Data Techniken in der Arbeitsmarktforschung des IAB\u0000","authors":"Susanne Rässler","doi":"10.1007/S10182-006-0010-1","DOIUrl":"https://doi.org/10.1007/S10182-006-0010-1","url":null,"abstract":"","PeriodicalId":84131,"journal":{"name":"Allgemeines statistisches Archiv","volume":"90 1","pages":"527-552"},"PeriodicalIF":0.0,"publicationDate":"2006-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/S10182-006-0010-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51986367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-11-18DOI: 10.1007/S10182-006-0004-Z
D. Rubin
{"title":"\u0000 Conceptual, computational and inferential benefits of the missing data perspective in applied and theoretical\u0000 statistical problems\u0000","authors":"D. Rubin","doi":"10.1007/S10182-006-0004-Z","DOIUrl":"https://doi.org/10.1007/S10182-006-0004-Z","url":null,"abstract":"","PeriodicalId":84131,"journal":{"name":"Allgemeines statistisches Archiv","volume":"90 1","pages":"501-513"},"PeriodicalIF":0.0,"publicationDate":"2006-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/S10182-006-0004-Z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51986304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-11-16DOI: 10.1007/S10182-006-0002-1
Gabriele B. Durrant
{"title":"\u0000 Missing data methods in official statistics in the United Kingdom: Some recent developments\u0000","authors":"Gabriele B. Durrant","doi":"10.1007/S10182-006-0002-1","DOIUrl":"https://doi.org/10.1007/S10182-006-0002-1","url":null,"abstract":"","PeriodicalId":84131,"journal":{"name":"Allgemeines statistisches Archiv","volume":"90 1","pages":"577-593"},"PeriodicalIF":0.0,"publicationDate":"2006-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/S10182-006-0002-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51986284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-11-16DOI: 10.1007/S10182-006-0011-0
U. Rendtel
{"title":"\u0000 The 2005 Plenary Meeting on ‘‘Missing Data and Measurement Error’’\u0000","authors":"U. Rendtel","doi":"10.1007/S10182-006-0011-0","DOIUrl":"https://doi.org/10.1007/S10182-006-0011-0","url":null,"abstract":"","PeriodicalId":84131,"journal":{"name":"Allgemeines statistisches Archiv","volume":"90 1","pages":"493-499"},"PeriodicalIF":0.0,"publicationDate":"2006-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/S10182-006-0011-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51986375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-11-10DOI: 10.1007/S10182-006-0012-Z
C. Schmidt
{"title":"\u0000 Fokus, Fokus, Fokus? Zur künftigen Rolle der außeruniversitären Wirtschaftsforschungsinstitute\u0000","authors":"C. Schmidt","doi":"10.1007/S10182-006-0012-Z","DOIUrl":"https://doi.org/10.1007/S10182-006-0012-Z","url":null,"abstract":"","PeriodicalId":84131,"journal":{"name":"Allgemeines statistisches Archiv","volume":"90 1","pages":"617-622"},"PeriodicalIF":0.0,"publicationDate":"2006-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/S10182-006-0012-Z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51986384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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